Despite significant efforts by hospital administrators and the local board of directors to secure its future, Lee Regional Medical Center will join the list of hospitals across the country to close in an era of unprecedented changes to health care.

Three issues are the primary reasons that have led to this decision - reimbursement cuts associated with the Affordable Care Act, extremely low community use of the hospital and a lack of consistent physician coverage.

Lee Regional will cease all operations on Oct. 1, but patients who need a broad spectrum of care will still have seamless access to other Wellmont Health System facilities in the community and throughout the region. Wellmont Medical Associates will work with other community partners to assess what outpatient services are most needed and how those could be best served in the region.

"We had certainly hoped Lee Regional could remain open as a hospital and continue serving the community, but the difficult realities facing our facility are too much to overcome," said Fred Pelle, the hospital's interim president. "We remain committed to serving the health needs of people who live and work in Lee County and will assist them in whatever way possible in this transition."

The closure is due in part to major cuts in Medicare reimbursements by the federal government associated with the Affordable Care Act and a lack of Medicaid expansion by the commonwealth of Virginia. Another factor is the additional 2 percent cut in Medicare reimbursements enacted because of the federal sequester.

More than 60 percent of the hospital's payments comes from federal and state programs.

Through the American Hospital Association, hospitals across the country agreed to initial cuts in the reimbursements with the understanding Medicaid would be expanded to compensate for that lost revenue. But the U.S. Supreme Court's ruling on the Affordable Care Act left it to the states to decide whether Medicaid should be expanded.

Virginia has put the issue in the hands of a commission consisting of delegates and senators but reached no conclusion. In the interim, the steep cuts have profoundly impacted the financial ability of hospitals in the region and across the country to survive.

"These political decisions clearly can have dire ramifications for small communities and the hospitals that serve them," said Denny DeNarvaez, Wellmont's president and CEO. "For months, Wellmont and other health systems in the region and across the country have outlined the consequences of these cuts on community health. While our local legislators have been understanding, there is simply not a supportive state or national climate overall to effectively resolve this matter.

"The national goal is to reduce costs and keep people out of the hospital. This is a noble initiative, but the cuts are hitting faster than struggling rural hospitals can respond."

Another matter that has affected Lee Regional's ability to continue as a hospital is finding physicians to take call coverage at the hospital.

Pelle said physicians who provided call coverage notified Lee Regional administrators that they would no longer provide this service as of Oct. 1.

"Hospitals rely on physicians from the community for call coverage," Pelle said. "When that coverage is no longer available, no one can appropriately manage patient care in the hospital. We cannot create the quality or environment of care the community needs and deserves without a reservoir of physician coverage."

Additional efforts to work with these physicians on a potential solution produced no plan that was sustainable for the hospital and the community, Pelle said.

The hospital has also experienced financial challenges due to a decrease in the number of patients in an economically distressed community obtaining care at the hospital. The hospital made several changes to respond to changing patient needs and reduced revenue, including reducing inpatient and intensive care services.

"Unfortunately, since that time, community usage of the hospital has continued to decline to an average daily census of only a handful of patients," Pelle said. "Emergency department and outpatient volumes have also fallen during this time. Even though we made appropriate adjustments in our staffing volumes, the financial losses were expected to be $4 million or more per year in the coming years."

Pelle said Lee Regional is focused on helping co-workers at the hospital obtain new jobs. The hospital employs about 140 people, slightly more than 1 percent of the county's workforce, and these co-workers will receive severance pay. Pelle said these co-workers served Lee Regional and the patients they treated with great pride.

Wellmont Medical Associates will also work relentlessly to help patients obtain the care they need. The community assessment that will be undertaken might lead to the development of after-hours clinics, telemedicine consults, testing, imaging, chronic disease management services and visiting specialty physician clinics.

Plus, nearby Lonesome Pine Hospital and Holston Valley Medical Center, which serves dozens of people from Lee County every day, are equipped to treat patients from Lee County. These hospitals have also committed to begin new care management efforts for patients transitioning to home health or nursing homes in the county.

WellmontOne Air Transport and Med-Flight II, which have many of the same pieces of equipment used in Wellmont emergency departments, are also ready to assist patients in Lee County with rapid transport. Whether they reach patients via the helipad that will remain available at Lee Regional or at the scene, paramedics and flight nurses on these aircrafts will be available to deliver lifesaving care. The helicopters can reach Holston Valley in 12 minutes and Bristol Regional Medical Center in 18 minutes from Lee Regional.

In addition, Wellmont has instituted a patient navigation and information service to assist residents of the county with any questions related to accessing the services they need. Medical professionals can also be accessed at any time by calling 1-877-230-NURSE (6877) for general medical questions or assistance scheduling testing or hospital services.

"Do not hesitate to access these services and facilities because they are designed help patients and the community during this transition," Pelle said. "We have had the honor of serving Lee County for many years with high-quality care, and that will continue to be our approach well into the future."